Chronic Anal Fissures: Treatment Options and Dietary Tips

Anal fissures are difficult to heal?

I have been suffering from an anal fissure for six months now (I also have mild internal hemorrhoids).
During this time, I have visited two hospitals and a clinic, but I still haven't seen improvement.
I have been consuming enough fluids (about 2000-2500 ml per day) and drinking fiber-rich milk powder and oatmeal.
However, I recently noticed a problem: the front part of my stool is hard, while the back is soft (though somewhat bulky).
I may not have noticed this before, or it might have just started happening.
Is this a sign of constipation?
After showering at night, I use petroleum jelly to assist in massaging the anal area (I insert it inside).
Recently, I found that when I go deeper, I can feel some hard, black stool that can be removed, but this doesn't happen every time.
I tried this once before but ended up irritating the anal area, so I was hesitant to do it again for fear of worsening the fissure.
I wonder if the hard front part of my stool is due to leftover stool from the previous bowel movement.

Additionally, I have noticed an increase in bleeding over the past two days (I usually have bowel movements in the morning).
I feel pain at the anal opening when passing stool, and there is blood on the stool and on the toilet paper.
Today, I observed that the blood is attached to the front part of the stool, and I can feel a soft, round mass inside the anal area.
Is this an internal hemorrhoid?
I am unsure if the increased bleeding over the past two days is due to the internal hemorrhoid or the anal fissure.
Since the onset of these symptoms, I have experienced significant bleeding only twice before, and this is the third time.
The last time I saw a doctor, they mentioned that my symptoms were not significantly related to my diet, but I have noticed that consuming even a small amount of fried or spicy food leads to bleeding the next day.
I wonder if this is a psychological effect because my bowel movements are generally normal, yet the fissure does not heal.

From what I have read, it seems that surgery is the only way to resolve an anal fissure.
Is it possible that self-care and the medications prescribed by my doctor are insufficient? Initially, I believed that I could manage it, but I am now worried that if the fissure continues, surgery may be my only option.
I would like to know if I can enhance my treatment methods (as I really want to avoid surgery).
For example, would taking stool softeners or consuming yogurt help with bowel movements? A few days ago, I drank a small bottle of yogurt and felt that my stool became softer, but there were still remnants left.
Is it okay to continue using yogurt?
Also, can I eat barbecue? I have noticed that after eating barbecue, I also experience bleeding.
I apologize for this lengthy message, but I have been troubled by these questions for a long time and would appreciate your guidance.

Niming, 20~29 year old female. Ask Date: 2011/10/26

Dr. Ke Fangxu reply Surgery

The user described many symptoms but did not mention any pain, which is actually the main characteristic of anal fissures.
If there is no pain, it is likely not an issue of anal fissure bleeding, but rather a problem with internal hemorrhoids.
Most cases can be managed with medication to control symptoms.
If medication is ineffective, ligation treatment can be performed in an outpatient setting to control bleeding.
It is common for a small amount of stool to remain in the rectum, which is not abnormal.
Please refrain from using fingers to dig or probe, as this may cause wounds or infections.
Dietary recommendations suggest a light and healthy diet, but meat is not prohibited.
If the bleeding does not improve, a colonoscopy should be performed to rule out other possible intestinal diseases.

Reply Date: 2011/10/26

More Info

Chronic anal fissures can be a painful and frustrating condition, especially when they persist for an extended period, as in your case. It’s important to understand both the underlying causes and the treatment options available to manage your symptoms effectively.

Understanding Anal Fissures
An anal fissure is a small tear in the lining of the anus, which can cause significant pain, especially during bowel movements. The presence of hard stools can exacerbate the condition, leading to further tearing and discomfort. Given your description of your stool consistency—hard at the front and softer at the back—it does sound like you may be experiencing a form of constipation, which can contribute to anal fissures.

Symptoms and Concerns
The symptoms you describe, including blood on the toilet paper and pain during bowel movements, are classic signs of an anal fissure. The fact that you have noticed a soft, round mass may indicate the presence of hemorrhoids, which can coexist with fissures. The increased bleeding you’ve experienced could be due to either the fissure or the hemorrhoids, especially if you’ve consumed foods that irritate your digestive system, such as spicy or fried foods.

Dietary Recommendations
1. Increase Fiber Intake: While you are already consuming fiber-rich foods like oats and fiber supplements, it’s crucial to ensure that you are getting enough soluble fiber. Foods such as fruits (bananas, apples), vegetables (carrots, broccoli), and whole grains can help soften stools.

2. Hydration: You mentioned drinking 2000-2500 ml of water daily, which is excellent. Staying well-hydrated is essential for preventing hard stools.

3. Probiotics: Incorporating probiotics, such as yogurt or kefir, can help improve gut health and stool consistency. You noted that consuming yogurt seemed to help; it’s worth continuing this.

4. Avoid Irritating Foods: As you’ve observed, spicy and fried foods can exacerbate your symptoms. It’s advisable to limit these foods and monitor how your body reacts to different dietary choices.

5. Softening Agents: If you find that your stools are still hard, consider using stool softeners or laxatives as recommended by your healthcare provider. These can help ease the passage of stools and reduce strain during bowel movements.

Treatment Options
1. Topical Treatments: Over-the-counter creams containing hydrocortisone or prescription medications like nitroglycerin ointment can help relax the anal sphincter and promote healing.

2. Sitz Baths: Regular sitz baths can soothe the area and promote healing. Soaking in warm water for 10-15 minutes several times a day can provide relief.

3. Avoid Straining: When you feel the urge to have a bowel movement, try not to delay it. Straining can worsen fissures.

4. Consult a Specialist: If your symptoms persist or worsen, it may be beneficial to consult a gastroenterologist or a colorectal surgeon. They can provide further evaluation and discuss options such as Botox injections or surgical interventions if necessary.

When to Seek Immediate Care
If you experience significant bleeding, especially if it’s more than what you’ve previously encountered, or if you notice any signs of infection (such as fever or increased pain), seek medical attention promptly.

Conclusion
While chronic anal fissures can be challenging to manage, a combination of dietary adjustments, proper hydration, and topical treatments can often lead to improvement. It’s essential to monitor your symptoms closely and maintain open communication with your healthcare provider to explore all available treatment options. If conservative measures fail, surgical options may be considered, but many patients find relief through non-invasive methods.

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